면양에서 개량된 제1위 누관 형성술 1례

김명철,김종만,김용국,김덕환,이영원 충남대학교 수의과대학 동물의과학연구소 1999 動物醫科學硏究誌 Vol.7 No.-

We performed rumen fistula operation in a sheep. In sheep, the procedure for a rumen fistula is quite successful, but choice of an appropriate cannula is of prime importance. The sheep was anesthetized by xylazine(0.1 ㎎/㎏ IM) administration 5 minutes after administration of atropine sulfate(0.1 ㎎/㎏ IM). We inserted rubber cannula in rumen incised and put rubber ring after employing purse-string suture in rumen. We marked the area for the puncture incision in the body wall through which the cannula is drawn. We drew the cannula as near the transverse process of the lumbar vertebrae as possible to minimize leakage. We isolated the cannula by fixing the stainless washer which has small holes. The sheep was given postoperative penicillin(20,000 IU/㎏ IM) to prevent secondary infection for 3 days. There were not observed the leakage of rumen contents, the entering of rubber cannula into abdominal cavity, and necrosis on incision site and skin, over months after surgery.

개에서 발생한 폐수종의 치료 증례

김유수,심재현,김건우,김지용,이병희,송근호,이영원,김덕환 충남대학교 수의과대학 동물의과학연구소 2004 動物醫科學硏究誌 Vol.12 No.-

A 9 months intact male American bull dog with chief complaints of dry cough, dyspnea and fever was referred to the Veterinary Teaching Hospital, Chungnam National University. Based on the findings of physical examination, radiological examination, and blood and blood chemical examinations, the present patient was diagnosed into pulmonary edema secondary to primary bacterial and aspiration pneumonia. The patient was hospitalized and treated with buscopan, cephazolin and furosemide for 1 week. His activity and appetite was returned to normal and thoracic radiographs revealed that Jung was recovered to the normal condition after treatment for 7 days. The present patient was a case with pulmonary edema showed favorable therapeutic responses to proper medication.

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

급성신부전증 이환견에 대한 복막투석 치료 1례

김건우,이병희,김유수,심재현,김지용,이영원,김덕환,송근호 충남대학교 수의과대학 동물의과학연구소 2004 動物醫科學硏究誌 Vol.12 No.-

A fourteen-month-old intact female Poodle was referred to the Veterinary Teaching Hospital, College of Veterinary Medicine, Chungnam National University. The patient was presented with history of vomiting, inappetence, ataxia, insomnia, tachypnea and convulsion for 5 days. Biochemical examination revealed BUN (254.2 mg/dl), creatinine (9.22 mg/dl) and phosphate (14 mg/dl). Epithelial cells of urinary tract, neutrophils, macrophages, a large number of gram negative and smaller number of gram positive bacteria were presented on urine test. Ultrasonographic findings show hyperechogenic kidney and indistinguishableness of renal cortex and medulla. Based on the results of examination described above, this case was diagnosed as acute renal failure with interstitial nephritis by urinary tract infection (UTI). Treatments with fluids therapy, diuretics, and peritoneal dialysis during hospitalization showed good results with no clinical signs.

단일공법 복강경하 질식자궁절제술 110예의 고찰 및 다공법과의 비교

박병준 ( Byung Joon Park ),김용욱 ( Yong Wook Kim ),노덕영 ( Duck Yeong Ro ),김태응 ( Tae Eung Kim ),류기성 ( Ki Sung Ryu ),김장흡 ( Jang Heup Kim ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.7

목적: 통상적인 복강경기구만을 사용한 단일공법 복강경하 질식자궁절제술을 다공법 복강경하 질식자궁절제술과 비교하여 안전성 및 유용성을 평가하고자 하였다. 연구 방법: 2007년 4월부터 2009년 11월까지 인천성모병원에서 자궁근종 또는 자궁샘근증의 질환으로 단일공법 복강경하 질식 자궁절제술을 시행받은 환자 110명과 다공법 복강경하 질식자궁절제술을 시행받은 환자 110명, 총 220명의 환자를 대상으로 하였다. 우리는 모든 수술에서 통상적으로 사용되는 구부러지지 않는 일직선의 복강경기구를 사용하였다. 또한 단일공법 및 다공법 복강경하 질식자궁절제술 둘 다에서 수술자 (Kim, YW)의 이름을 따서 명명한 새로운 질단부 봉합 방법인 김씨 질구개 현수법 (Kim`s Vaginal Vault Suspension Method)을 사용하였다. 결과: 환자 나이, 수술 시간, 자궁의 무게, 혈색소 수치의 변화, 수혈 빈도, 수술 후 발열에서 두 군 간에 유의한 차이를 보이지 않았다. 환자들의 평균 나이는 46.7±7.0세(단일공법)와 45.5±6.3세(다공법)이었다. 평균 수술 시간은 87.2±21.0분(단일공법)과 83.3±20.3분(다공법), 평균 자궁의 무게는 261.4±139.7 g(단일공법)과 257.8±132.9 g(다공법), 평균 혈색소 수치의 변화는 1.1±0.7 g/dL(단일공법)와 1.2±0.6 g/dL(다공법)이었다. 두 군 모두에서 수술 중 장 또는 요로의 손상은 없었다. 두 군 모두에서 각각 한 건의 개복수술로의 전환이 있었다. 단일공법을 시행한 군에서 입원 기간이 유의하게 짧았다(2.6±0.6일 [단일공법], 3.3±0.7일 [다공법], P<0.05). 결론: 통상적으로 사용하는 구부러지지 않는 일직선의 복강경기구를 이용한 단일공법 복강경하 질식자궁절제술은 다공법 복강경하 질식자궁절제술에 대한 안전하고 유용한 대체 수술이 될 수 있다. Objective: To evaluate the safety and feasibility of single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) using conventional laparoscopic instruments compared to multi-port access laparoscopically assisted vaginal hysterectomy (MPA-LAVH). Methods: We reviewed the medical records of 220 patients with uterine leiomyoma or adenomyosis who underwent 110 SPA-LAVH and 110 MPA-LAVH in Incheon St. Mary`s Hospital between April 2007 and November 2009. We performed SPA-LAVH with conventional rigid straight laparoscopic instruments in all cases. We also performed a new vaginal cuff closure method, Kim`s Vaginal Vault Suspension Method, named after the operator (Kim, YW) in both SPA-LAVH and MPA-LAVH. Results: There was no significant difference in patients` age, operating time, uterine weight, hemoglobin change, frequency of blood transfusion, and incidence of postoperative fever between the two groups. The patients` mean age was 46.1±7.0 years (SPA-LAVH) and 45.5±6.3 years (MPA-LAVH). The mean operating time was 87.2±21.0 minutes (SPA-LAVH) and 83.3±20.3 minutes (MPA-LAVH). The mean uterine weight was 261.4±139.7 g (SPA-LAVH) and 257.8±132.9 g (MPA-LAVH). The mean hemoglobin change was 1.1±0.7 g/dL (SPA-LAVH) and 1.2±0.6 g/dL (MPA-LAVH). Neither bowel injury nor urinary tract injury occurred during the operation in the two groups. One of the SPA-LAVH and one of the MPA-LAVH cases were converted to abdominal total hysterectomy. The mean hospital stay time was shorter with SPA-LAVH (2.6±0.6 days [SPA-LAVH] and 3.3±0.7 days [MPA-LAVH], P<0.05). Conclusion: SPA-LAVH using conventional rigid straight laparoscopic instruments can be offered as a safe and feasible alternative to MPA-LAVH.

3 Henry VI의 구조

김용덕 동아대학교 문과대학 영어영문학과 1986 동아영어영문학 Vol.2 No.-

A Woman of No Importance의 구조와 주제

김용덕 동아영어영문학회 1998 동아영어영문학 Vol.14 No.-

This is an attempt to study the thematic structure of Wilde's second successful society drama, A Woman of No Importance, through the close examination of the play. Wilde's doctrine was in essence that of a utopian anarchist, preaching the doctrine of individualism and aestheticism. Wilde always liked to create manly women and womanly men, as a challenge to the stratified thinking of his day and demonstrates through the characterization of female leads that the gender-antitheses of the age were almost meaningless. The play appears to be a conventional melodrama of seduction and judgement, a play whose only originality is to plea for greater leniency for repentant fallen women and harsher punishment for fallen men. Yet with the construction of A Woman of No Importance Wilde attempted to find a dramatic method for the presentation of thought as action, to challenge the century's convention. A consequence of this radical experiment is that the play suffers from inconsistencies of style and it has been underestimated in Wilde's canon. A Woman of No Importance is not a play of 'action', a traditionally male preserve, but 'a woman's play' of female leads. Female characters dominate the play and three types of 'new woman' are delineated in the characters of Mrs. Arbuthnot, Hester, and Mrs. Allonby. Together they act out a confrontation with all sexual laws and restrictions, showing them to be both ineffectual against the power of passion and impulse. Whereas the women of Hanstanton take advantage of their supposedly weaker status to manipulate the men around them, Mrs. Arbuthnot struggles with an absolute morality which denies all her true instincts as a woman Thus every woman in this play is an individualist in her own way, while male dandy Lord Illingworth leaves the stage, defeated and insulted not for interfering Hester's puritan standards but for compromising his own, that is, for lack of true individualism.

셰익스피어 사극의 제1사부작 연구 : Henry VI 삼부작을 중심으로

金容德 東亞大學校 大學院 1986 大學院論文集 Vol.11 No.-

The purpose in this paper is to study the thematic structure of Shakespeare's first tetralogy by closely and form. Historical critics propose, based on the Elizabethan world Order, that these plays are primarily moralistic tracts in dramatic format in consonance with conventional Tudor attitudes and Machiavelli argues that the exercise of power is independent not only of theology but of morality as well. A detailed analysis of the plasys shows that far from reflecting and political ideology or any partisan moral outlook the plays are committed to dealing with the moral effects of power. In 1 Henry Ⅵ the structure of the play is built upon a clash between "chivalric patriotism and Machiavellian egocentricity" and the carefully designed soliloquies and asides give coherence to the fundamental theme. Shakespeare establishes in the minds of his audience a cause-and-effect relationship and the pattern of human motivation through the simple device of having an incident of discord followed by an announcement of loss. From the wide range of events of discord in Hall, shakespeare selected two most important combinations of discord-among Lancastrians and between Lancastrians and Yorkists(though he omitted Hall's almighty). The seeds of the present conflict were sown during the reign of Henry Ⅴ, and Henry Ⅵ, himself, has perpetuated dissent between Winchester and Gloucester through his blundering attempts to mediate between them. In 2 Henry Ⅵ Shakespeare achieves a more dramatic coherence by centering the action on two individuals-the fall fo Gloucester and the rise of York. The personal motives underlying York's destructive Machiavellism surface in the opening scene unlike in Hall, shakespeare deliberately emphasizes Henry Ⅵ's role in creating political chaos in his treatemnt of one of the most bestowal of a dukedom on Suffolk, a subject who has done much to undermine the regime. In 3 Henry Ⅵ shakespeare achieves thematic unity through a series of scenes which force the audience alternatively to respond with antipathy to pro-Lancastrian and pro-Yorkis figures, based on the external pattern of repugnance to the physical atrocities of war and man's brutality. By juxtaposing Henry's increasing moral sensitivity with Richard's stylized Machiavellianism. shakespeare provokes increasing sympathies for the victims of the struggle and reinforces the theme of moral anarchy due to Nachiavellian Realpolitik. Richard;s attempt to cut off Henry's prophesy and his acknowlegement of its truth after Henry's death indicates Shakespeare's intentions in his first tetralogy. Henry casts a shadow over Richard's career which is not so apparent if we read Richard Ⅲ as an isolated play. As a result, we must view character and action from the moral perspective introduced by Henry, not from the diabolical perspective of Richard, who dominates the play. In Richard Ⅲ, Richard's Machiavellism is bitterly criticized by the hymanistic voices of child and female characters. The dilemma between the two antithetical forces-hymanity and power-forms the tension of shakespeare's history plays. The theme of the first tetralogy is the morally corruptive influence of power. This is the Machiavellian divorce of public from private morality which manifests inself in Lancastrian and Yorkist concerns with power. But Shakespeare particularly emphasizes the moral effect of Machiavellian Realpolitik. This theme has been worked out in each play through the structure of offering a countervailing value to the inhumanity arising from the abus eof power. In the process of this thematic development, human motivations are stressed more than either Providence or fortune, and the conflicts inpersonalities and the rvalues they represent are embodied within the plays, providing their unity.

電子船荷證券과 電子決濟시스템의 問題點 및 向後 對應戰略

김용덕,임경범 한국해운물류학회 2002 해운물류:이론과실천 Vol.- No.4

현재 전자무역시스템과 관련되어 주목받고 있는 것으로는 볼레로(Bolero), SWIFT, 그리고 무역카트(Trade Card) 시스템이 대표적이다. 볼레로는 전자선하증권, SWIFT는 전자신용장, 무역카드는 새로운 전자무역시스템을 통한 전자결제를 언급하고 있다. 특히 전자신용장 방식의 결제측면에서 볼레로와 SWIFT는 매우 깊은 연관을 가지고 있으며, eUCP의 발표로 인하여 신용장 방식의 전자화 및 전자결제의 가능성을 더욱 높이고 있다. 한편 무역카드는 신용장을 배제한 전자교역 절차와 기업의 신용평가 및 지급보증을 통해서 전자결제의 안정성을 도모하고 있다. 이러한 전자무역시스템은 각각 특유의 법률 그리고 기술구조를 가지고 있으며 관련업체를 유인할 수 있는 장점을 가지고 있으나 단점 또한 적지 않다. 따라서 본고는 볼레로, SWIFT, 무역카드로 대변되는 전자선하증권, 전자신용장, 전자결제시스템의 법률 및 기술상의 유용성과 문제점 그리고 향후 대응전략을 살펴보고 있다. BOLERO System, SWIFT, and Trade Card System have recently been used as major electronic payment systems in relation to the electronic trade. Electronic bill of lading from BOLERO, electronic letter from credit of SWIFT, and a new electronic trade procedure from Trade Card as the payment systems are covered in this paper. These electronic payment systems have some merits to attract trade-related companies, but it is also true that they hold the legal and technical problems. In other words, there still remain some problems that these transaction procedures have to solve in order to match the established one. However, these systems will eventually be settled down as the global electronic trade methods, as actual experiences from those transactions accumulate more and more. Specifically, we have to remember that a future plan of BOLERO is not expansion of the electronic Bill of lading, but the electronic trade. Thus this paper prepares for the conditions that SWIFT service could be provided by the Internet of combined with various electronic transaction model. It also prepares for legal instability of the Trade Card system in building electronic process of trade firms.

일부 농촌부인의 자궁경부암 집단검진시 수진과 관련된 결정요인의 분석연구

金順德,廉容泰,李明淑 고려대학교 의과대학 1988 고려대 의대 잡지 Vol.25 No.3

Among the females in Korea, cervical cancer is the most common malignant tumor. Exfoliative cytology is a highly sensitive and inexpensive screening technique for cervical cancer and its precursors. The detection and eradication of the precursors have led to a significant fall in cervical cancer incidence and mortality rates in those areas of some developed countries in which there has been widespread and prolonged use. Interviews were carried out during the period from December,1986 to March, 1987 to study the determinants of the positive health seeking behavior of married women living in Jeomdong Myon, Yeoju Kun, Kyonggi Province focusing on the cervical cancer screening. Interviewed were 291 married women who participated in the cervical cancer screening and 249 who didn't. The path analysis and the discriminant analysis were used to identify major determinants for the health behavior concerned with cervical cancer screening. The results of this study were summarized as follows: 1. Belief, motive and action levels to the cervical cancer screening were 87.5%, 70.2% and 53.9% each. Belief and motive levels were 95.5%, 62.8% in the participants of the screening, and 78.2%, 33.3% in nonparticipants. 2 Determinants for the belief were age, regular health check up, benefit, susceptibility, level of knowledge, marital status, and interpersonal interaction. These determinants were able to explain 28.5% of the belief. 3. Determinants for the motive were belief, symptom, acquaintance who participated in cervical cancer screening, benefit, age, regular health check up, interpersonal interaction, acquaintance of cancer cases other than cervical cancer, and level of knowledge. These determinants were able to explain 26.9% of the motive. 4. Determinants for the action were occupation, age, symptom, belief, marital status, acquaintance who participated in cervical cancer screening, motive, some basic medical equipment kept in home, interpersonal interaction, acquaintance with cervical cancer patient, and mass media communications. These determinants were able to explain 37.8% of the actions. The variables having indirect effects on the actions through the belief and motive were susceptibility, benefit, level of knowledge, acquaintance with cancer cases other than cervical cancer, and regular health check up. 5. The belief was able to explain 18.2% of the motive, belief and the motive was able to explain 9.8%of the action. 6. The hit ratio was 78.82% for the prediction of the action in the discriminant analysis with the discriminating variables.